Rotator cuff debridement compared with rotator cuff repair in arthroscopic treatment of calcifying tendinitis of the shoulder: A systematic review and meta-analysis. / Desbridamiento frente a reparación asociada del manguito rotador en el tratamiento artroscópico de la tendinitis calcificante del hombro: una revisión sistemática y metaanálisis.

INTRODUCTION: Although conservative treatment of calcific tendinopathy has a high success rate, arthroscopic excision of the calcific deposit is occasionally necessary. Controversy exists as to whether the remaining rotator cuff defect can be left in situ or should be repaired to achieve better functional outcomes. This study aimed to compare the results of debridement versus debridement combined with suturing in arthroscopic surgery for calcific tendinopathy. METHODOLOGY: MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched from inception to February 2023 for articles on arthroscopic treatment of calcific tendinopathy. Functional outcomes (VAS, ASES, UCLA, and Constant) and the number of complications were analyzed. The effect size was calculated using Cohen's d-index. RESULTS: Twenty-one studies were included, including a total of 1172 patients aged between 44.7 and 55 years. The mean follow-up time was 24.7 months. The combined ES estimates for the total score of the VAS, ASES, UCLA, and Constant scales were very strong (>1.0) for both debridement and combined debridement with suture. The ES estimates for the number of total complications were 1.75 (95% CI: 0.08-3.43, I2 = 0%) for debridement and 9.07 (95% CI: -0.03-18.17, I2 = 50.4%) for combined debridement with suture. CONCLUSIONS: Both arthroscopic procedures improve the total score significantly on the EVA, ASES, UCLA, and Constant scales. However, a higher proportion of complications was observed in the group that performed suturing. In this regard, we must consider whether it is really necessary to repair all partial tears after the calcified deposits removal.

Meningitis linfocitarias causadas por el virus herpes simple tipo 2 / Lymphocytic meningitis caused by herpes simplex virus type 2

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Relationships between Serum Levels of Atazanavir and Renal Toxicity or Lithiasis.

The main aim of this study is to describe the relationship between serum levels of atazanavir, renal toxicity, and lithiasis. This is a prospective observational study of patients being treated with atazanavir (ATV) at Son Espases Teaching Hospital, Palma de Mallorca, between 2011 and 2013. The study includes 98 patients. Sixteen were found to have a history of urolithiasis. During a median monitoring period of 23 months, nine patients suffered renal colic, in three of whom ATV crystals were evidenced in urine. Cumulative incidence of renal colic was 9.2 per 100 patients. The variables related to having renal colic were the presence of alkaline urine pH and lower basal creatinine clearance. The mean serum level of ATV was slightly higher in patients with renal colic-1,303 µg/L versus 1,161 µg/L-but did not reach statistical significance. Neither were any significant differences detected by analysing the levels according to the timetable for ATV dosage. Cumulative incidence of renal colic was high in patients being treated with ATV, in 33% of whom the presence of ATV crystals was evidenced in urine. We were unable to demonstrate a relationship between ATV serum levels and renal colic or progression towards renal failure.

La rotura del manguito rotador: etiología, exploración y tratamiento / Partial tear of the rotator cuff: etiology, examination and treatment

Se presenta una revisión de las causas etiológicas de la rotura del manguito de los rotadores, su exploración y las indicaciones del tratamiento quirúrgico. Se establecen las posibles causas etiológicas y las correlaciones entre la anatomía y la rotura del manguito para intentar establecer las indicaciones de tratamiento (AU)

A review is presented of the etiological causes of tear of the rotator cuffs, its examination and indications for surgical treatment. Possible etiological causes and correlations between anatomy and tear of the rotator cuff are determined attempting to establish the indications for treatment (AU)

Tibiocalcaneal arthrodesis: a new arthroscopic procedure.

Tibiocalcaneal arthrodesis is considered an aggressive and technically demanding procedure that can be used to treat severe deformities of the hindfoot, and it is rarely performed. The indications for ankle arthroscopy are increasing, and arthroscopic tibiotalar arthrodesis is a common and successful procedure, but arthroscopic tibiocalcaneal arthrodesis has not been previously reported in the literature. A case of extensive talus necrosis with severe hindfoot deformity treated by means of an arthroscopic tibiocalcaneal arthrodesis is presented.

Osteotomía valguizante tibial en pacientes jóvenes con genu varo y cambios degenerativos incipientes / Valgus tibial osteotomy in young patients with genu varus and incipient degenerative changes

Objetivos: demostrar la relación de la posición de la placa de apertura con la corrección del varo y la pendiente, en ostetomías tibiales. Material y metodología: estudio retrospectivo, con dos grupos de pacientes, A: 29 pacientes (26 hombres y 3 mujeres ) con gonartrosis medial y genu varo, tratados con osteotomías de cierre. Edad media 53 años. B: 29 pacientes (25 hombres y 4 mujeres) con osteotomías de apertura. Edad media 42 años. Las osteotomías de cierre se fijaron con grapas y las de apertura con placas. Se midieron el eje anatómico, el ángulo de corrección y la pendiente del platillo tibial, previos a la cirugía y a la 10ª semana. En el grupo B, se analizó la posición de la placa en el plano lateral. Resultados: La corrección del eje anatómico fue de 4,7º en las osteotomías de cierre y 7º en las de apertura. El eje fémoro-tibial aumentó con las placas de mayor tamaño (p≤0,02). En las osteotomías de cierre disminuyó la pendiente tibial (0,32º) y en las de apertura aumentó (5,68º). Las placas situadas por delante aumentaron la pendiente tibial (p≤0,004). Conclusión: en la osteotomía tibial de apertura, conviene situar la placa lo más posterior posible, para evitar la traslación anterior de la tibia, aumentar la tensión sobre el LCA y conseguir mayor corrección del valgo (AU)

Objetives: To demonstrate the relationship between the position of the opening plate with respect to varus and slope correction in tibial osteotomies. Material and methods: A retrospective study was made involving two groups of patients, A: 29 patients (26 males and 3 females) with medial gonarthrosis and genu varus, subjected to closing osteotomies. The mean age was 53 years; B: 29 patients (25 males and 4 females) with opening osteotomies. The mean age was 42 years. The closing and opening osteotomies were fixed with staples and plates, respectively. Measurement was made of the anatomical axis, the correction angle and slope of the tibial plate before surgery and in week 10. In group B the position of the plate in the lateral plane was analyzed. Results: Correction of the anatomical axis was 4.7º and 7º in the closing and opening osteotomies, respectively. The femoral-tibial axis increased with the larger plates (p≤0.02). The tibial slope decreased (0.32º) and increased (5.68º) in the closing and opening osteotomies, respectively. The plates positioned anteriorly increased the tibial slope (p≤0.004). Conclusion: In opening tibial osteotomy it is advisable to position the plate as anterior as possible, in order to avoid posterior displacement of the tibia, increase tension upon the anterior cruciate ligament, and secure increased valgus correction (AU)

Relación entre el mecanismo de producción y las lesiones concomitantes en las roturas del ligamento cruzado anterior / Relationship between mechanism of injury and associated lesions in anterior cruciate ligament tears

Objetivo: Comprobar las alteraciones articulares y óseas que se producen en pacientes diagnosticados de rotura del ligamento cruzado anterior (LCA) y su relación con el mecanismo de producción. Material y método: Se seleccionó a 127 pacientes diagnosticados de rotura del LCA durante 1 año. Se evaluó el mecanismo de acción de la lesión según fuesen en valgo o varo forzado; 45 pacientes cumplieron los criterios de inclusión. Evaluamos las lesiones intraarticulares mediante resonancia magnética (RM) y visualización artroscópica directa; 33 pacientes tenían lesiones en valgo forzado y 12, en varo forzado. Se compararon las lesiones intraarticulares observadas en ambos grupos. Resultados: Las lesiones indirectas o sin contacto fueron más frecuentes, sin diferencias en cuanto a la aparición de lesiones meniscales o ligamentosas, vistas en RM, ni de lesiones meniscales, condrales femorotibiales y rotulianas, vistas por artroscopia. Sin embargo, detectamos 24 pacientes con lesiones óseas subcondrales en el grupo de valgo y sólo 2 en el grupo de varo; la diferencia entre ambos grupos fue significativa (p=0,002). Conclusiones: Hay relación entre el mecanismo de valgo forzado y las lesiones óseas subcondrales, que no se demostró en las lesiones en varo (AU)

Purpose: To analyze joint and bone alterations occurring in patients diagnosed with anterior cruciate ligament (ACL) tears and their relationship with the mechanism of injury. Material and method: Over one year, 127 patients were selected that had been diagnosed with an ACL rupture. The mechanism of injury was analyzed, i.e. whether the lesions had been caused by valgus tress or by forced varus. Forty-five patients fulfilled the inclusion criteria. We assessed intra-articular lesions by means of MRi and direct arthroscopic visualization and found 33 patients with forced valgus lesions and 12 patients with forced varus injuries. A comparison was made between the intra-articular lesions found in both groups. Results: Indirect or non-contact injuries were the most frequent, without any differences being identified as regards the appearance of meniscus or ligament lesions seen in the MRi scans or the meniscus and tibiofemoral and patellar cartilage lesions seen arthroscopically. Nonetheless, we identified 24 patients with subchondral bone lesions in the valgus injury group and only 2 in the varus group, with the difference between both groups reaching statistical significance (p=0,002).Conclusions: There exists a relationship between the forced valgus mechanism of injury and the presence of subchondral bone lesions. This relationship could not be demonstrated for varus injuries (AU)

Implante meniscal de colágeno asociado a rotura del ligamento cruzado anterior / Collagen meniscal implants with an associated tear of the anterior cruciate ligament

Objetivo: analizar el resultado clínico de los implantes meniscales de colágeno (CMI) combinados con roturas del ligamento cruzado anterior (LCA). Pacientes y métodose realizó el seguimiento de 37 varones y 1 mujer, con edades entre 22 y 50 años, a los que se implantó artroscópicamente un CMI en el compartimento medial de la rodilla asociado a plastia de ligamento cruzado anterior, semitendinoso y recto interno en 35 casos y con aloinjerto en 3. De los pacientes, 10 presentaban una lesión del menisco lateral en la misma rodilla. El intervalo de tiempo entre la lesión del LCA y la cirugía varió entre 3 semanas y 6 meses. Se evaluó a todos los paciente con la escala IKDC, radiografías en carga y resonancia magnética. La evolución fue entre 24 y 84 meses. Resultadosel IKDC, en 19 de los pacientes fue normal (A), en 14 casi normal (B), en 4 anormal (C) y en uno severamente anormal (D). El rango de movilidad fue normal en 26 pacientes y cercano al normal en 12. El KT-1000 fue normal en 30 pacientes, casi normal en 5, anormal en 1 y severamente anormal en 2. El estudio radiográfico en carga fue normal en 24 pacientes, casi normal en 7 y anormal en 7. Como complicaciones encontramos 8 implantes reabsorbidos a los 6 meses; 7 disestesias en territorio del nervio safeno, una rotura de plastia, una pérdida del CMI y 2 rigideces que precisaron movilización bajo anestesia. Conclusionesel CMI es una alternativa funcional en pacientes jóvenes con lesiones meniscales graves que asocian roturas del LCA, pero requiere futuros estudios y desarrollos técnicos antes de ser generalizada

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Cuándo aflojar el manguito neumático de isquemia: su influencia sobre las pérdidas hemáticas y posibles complicaciones en la prótesis total de rodilla. Estudio prospectivo multicéntrico / The timing of tourniquet release: its influence on blood loss and possible complications after total knee arthroplasty. A prospective multicenter study

Objetivo. Realizar un estudio prospectivo multicéntrico de selección alternante para valorar las pérdidas hemáticas postoperatorias de la prótesis total de rodilla en relación con el momento de soltar la isquemia, realizando o no hemostasia, y las posibles complicaciones locales y generales.Material y método. Se analizan 194 pacientes (194 rodillas) distribuidos en dos grupos homogéneos:1. Grupo I hemostasia (H): se libera el torniquete de isquemia después de la colocación de los implantes metálicos, realizando la hemostasia previa al cierre de la herida quirúrgica.2. Grupo II no hemostasia (NH): se coloca la prótesis, se realiza el cierre de la herida quirúrgica, se coloca vendaje compresivo y en este momento se afloja el manguito neumático.Resultados. El sangrado promedio total del grupo I (H) fue de 721cc. (30-2210) y el del grupo II (NH) fue de 625cc. (60-1540), no existiendo diferencias significativas entre ambos grupos (p = 0,3). No se encuentran tampoco diferencias significativas entre ambos grupos con respecto a las complicacioneslocales o generales.Conclusión. Las pérdidas hemáticas postoperatorias no serelacionan directamente con el momento de soltar la isquemia durante las prótesis totales de rodilla

Purpose. We conducted a prospective multicenter study with alternate selection methodology in order to evaluate postoperative blood loss further to primary knee replacement at the time of tourniquet release, with or without hemostasis, as well as possible local and systemic complications.Materials and methods. We studied 194 patients (194 knees) divided into two similar groups. Group I (Hemostasis - H) - the tourniquet was deflated intraoperatively after implantation of the metal components and hemostasis was achieved prior to wound closure. Group II (No Hemostasis - NH) - the tourniquet was released after the wound was closed and a compressive bandage applied.Results. Mean bleeding was 721ml (30-1540) for group I and 625 ml (60-1540) for group II. No statistically significant differences were found (p = 0.3). No significant differences were found between the groups as regards general or local complications.Conclusions. Postoperative blood loss is not related directly with the time of tourniquet release further to TKR. Our findings cast certain doubts on the efficacy of tourniquet release, which means that intraoperative hemostasis may not be necessary (AU)

Nuestra experiencia en cirugía de rescate de LCA con tendón de Aquiles liofilizado / Our experience in ACL revision with freeze dried Achilles allograft

Objetivo: analizar los resultados a medio plazo de losaloinjertos liofilizados en las revisión de plastias fallidas del ligamento cruzado anterior.Material y métodos: en 55 pacientes se realizó cirugíade revisión de plastia de ligamento cruzado anterior (LCA), edad media 29 años (rango: 19 y 51 años. El seguimiento medio fue de 24 meses (rango: 12 y 64 meses). La fijación proximal se hizo con un sistema trasfixiante y la fijación distal con tornillo interferencial. Se siguió el mismo protocolo postoperatorio en todos los pacientes. Se realizaroncontroles radiográficos y con RNM previos y a los 6,12 y 18 meses de la cirugía. Valoramos la evolución conla escala de Lysholm.Resultados: Veinte de los pacientes intervenidos referíansensación de inestabilidad en su rodilla después de la cirugía. En 10 casos se efectuó nueva cirugía de revisióncon injerto criopreservado. En RMN vimos un 30% de reabsorciones de la plastia, a los 18 meses y 33 casos presentaban signos de permeabilidad en el túnel tibial que disminuyó con el tiempo. En las radiografías encontramos un aumento del diámetro de los túneles tibiales. El rango de movilidad fue normal, 37 de los pacientes volvieron a su actividad diaria habitual. Los derrames después de la cirugía se presentaron en un 41% de los casos y tuvimos dos artritis sépticas (4%).Conclusión: hallamos un elevado número de problemas ycomplicaciones que nos han llevado a desistir en la utilización de las plastias liofilizadas

Purpose: To analyze the mid-term results of anterior cruciate ligament revision with freeze-dried allografts.Material and methods: 55 patients with failed ACL reconstruction were revised with freeze-dried Achilles allograft, mean age was 29 years (range between 19 and 51years). The mean follow-up was 24 months (range: 12 to64 months). Proximal fixation was achieved with the transfix device and distal fixation with interference screw. The postoperative protocol was the same in all patients. Radiographs and MRI were performed preoperative, and at 6, 12 and 18 months postoperative. We used the Lysholm Score to evaluate our results.Results: 20 patients complained of knee instability aftersurgery. Ten patients required further ACL revision withfresh-frozen allograft. MRI at 18 months showed 30%graft resorptions and 33 cases had tibial tunnel permeability which decreased with time. Radiographs showed dilated tibial tunnels. The range of motion was normal. 37 patients returned to their daily activities. Postoperative swelling was found in 41% of the cases and there were two septic arthritis (4%)Conclusion: We found a high number of problems andcomplications which have made us abandon the use offreeze-dried allografts (AU)

Orthotic and prosthetic devices in partial foot amputations.

With advanced surgical techniques and orthotic, as well as prosthetic devices, partial foot amputations have become a viable alternative. Orthotics can help restore stability, maintain support, and protect function of the residual limb. The authors discuss orthotic and prosthetic management of patients who have undergone toe amputations; ray amputations; transmetatarsal, Lisfranc-, or Chopart-level amputations.

Thrice-weekly sulfadiazine-pyrimethamine for maintenance therapy of toxoplasmic encephalitis in HIV-infected patients. Spanish Toxoplasmosis Study Group.

An open, randomised, multicentre trial was conducted to evaluate the efficacy of thrice-weekly versus daily therapy with sulfadiazine-pyrimethamine in the prevention of relapses of toxoplasmic encephalitis in HIV-infected patients. Between February 1994 and July 1997, 124 patients with HIV infection were enrolled after resolution of the first acute episode of toxoplasmic encephalitis treated with sulfadiazine-pyrimethamine. Patients were randomly assigned to receive either a daily regimen consisting of sulfadiazine (1 g) twice a day plus 25 mg pyrimethamine and 15 mg folinic acid daily (n = 58), or a thrice-weekly regimen consisting of the same doses of sulfadiazine and folinic acid plus 50 mg pyrimethamine (n = 66). After a median follow-up period of 11 months (range 1-39 months), no differences were found in the incidence of toxoplasmic encephalitis relapses between the groups, there being 14.9 episodes per 100 patient-years (95% CI: 2.8-20.2) in the daily-regimen group versus 14.1 episodes (95% CI: 2.3-17.2) in the intermittent-regimen group. The estimated cumulative percentages of relapse at 12 months were 17% and 19%, respectively (P = 0.91). In a Cox multivariate analysis, not taking antiretroviral therapy was the only variable independently associated with relapse (adjusted risk ratio: 4.08; 95%CI: 1.32-12.66). Baseline CD4+ cell counts, prior AIDS, mental status, sequelae and allocated maintenance therapy regimen were not independent predictors of relapse. No differences were observed in the survival rate (P = 0.42), or in the incidence of severe adverse effects (P = 0.79). The efficacy of the thrice-weekly regimen was similar to that of the daily regimen in the prevention of relapses of toxoplasmic encephalitis. Administration of antiretroviral therapy was the only factor associated with a lower incidence of relapse.

Distraction osteogenesis of the lower extremity with use of monolateral external fixation. A study of two hundred and sixty-one femora and tibiae.

We reviewed the results of distraction osteogenesis of 114 femora and 147 tibiae that had been lengthened to treat a variety of diagnoses. The femora had been lengthened an average of eleven centimeters (range, 3.5 to 17.0 centimeters), or 48 per cent (range, 8 to 86 per cent) of the original femoral length. The average total time for the treatment of the femora (use of the fixator and any subsequent immobilization) was 257 days (range, 105 to 420 days). There were 114 complications related to the femoral lengthenings, which led to eighty-seven additional operations. The tibiae were lengthened an average of nine centimeters (range, 3.0 to 15.6 centimeters), or 41 per cent (range, 9 to 100 per cent) of the original tibial length. The average total time for the treatment of the tibiae was 268 days (range, 110 to 497 days). There were 196 complications related to the tibial lengthenings, which led to 219 additional operations. The Achilles tendon was lengthened during or after seventy-three (50 per cent) of the tibial lengthenings. The femoral lengthenings that were performed to treat a limb-length discrepancy were associated with significantly higher rates of complications overall (p = 0.010) and additional operations (p = 0.023) for each percentage of length gained than those that were performed to treat achondroplasia or another skeletal dysplasia. The femoral lengthenings that were performed to treat short stature (of an endocrine or idiopathic etiology) were also associated with higher rates of complications overall and additional operations than those performed to treat skeletal dysplasias, but the rates were lower than those for lengthenings performed to treat limb-length discrepancy. The rate of complications overall associated with femoral lengthening in patients who were fourteen years old or more was significantly higher than that associated with lengthening in patients who were less than fourteen years old (p = 0.047). Femoral lengthening through the metaphysis was associated with significantly higher rates of complications overall (p = 0.031) and additional operations (p = 0.042) for each percentage of length gained than femoral lengthening through the diaphysis. The tibial lengthenings that were performed to treat Turner syndrome and idiopathic short stature were associated with significantly higher rates of complications overall (p = 0.026) and additional operations (p = 0.003) for each percentage of length gained than those performed to treat skeletal dysplasias. The rate of joint-related problems (p = 0.044) and that of additional operations (p = 0.053) after tibial lengthening in patients who were fourteen years old or more were significantly higher than those rates after tibial lengthening in patients who were less than fourteen years old. The site of the tibial osteotomy did not affect the rate of complications or additional operations. The femoral healing indices (in terms of both days per centimeter [p = 0.002] and days for each percentage of length gained [p = 0.019]) were significantly higher in the patients who were fourteen years old or more than in those who were less the fourteen years old. These values could not be used to predict an increase in the complications because of poor bone formation. The results of the present review suggest that the use of healing indices to gauge the final outcome of distraction osteogenesis is questionable; we were unable to discern significance or clinical importance from appropriately adjusted values.

Statistical analysis of axial deformity during distraction osteogenesis of the tibia.

In this study, we documented the prevalence of coronal axis malalignment in a series of 93 tibias (from 54 patients) lengthened with monolateral fixation. The average length obtained by distraction osteogenesis was 8.9 cm (range, 3.5-15.6) or 38% of the original bone length (range, 11-78%). Fifty (54%) of 93 tibias had documented valgus angulation of > or = 10 degrees or had fixator manipulation during the lengthening process for undesirable or progressive angulation; no cases of varus angulation were noted. Thirteen (14%) segments had later corrective osteotomy for unsatisfactory valgus malalignment. Statistical analysis revealed two factors to have a significant effect on the rate of malalignment. Those cases that had tibial osteotomy below the proximal one third of the original tibial length and those cases in which the fixator was placed > 5 degrees out of parallel had higher rates of angulation or manipulation (p < 0.001 and p = 0.002). Although the percentage of original bone lengthened was not statistically significant (p = 0.083), it did have an important effect on rates of axial malalignment. From this study we conclude that relatively high rates of malalignment in the tibia during distraction osteogenesis with monolateral external fixation are predominately the result of more distal osteotomies and nonparallel fixator placement. Attention to these details in general, and particularly where long lengthenings are planned, may significantly reduce this common complication.

Spontaneous osteonecrosis of the knee. Treatment and evolution.

We performed a retrospective study on 21 patients affected by unilateral spontaneous osteonecrosis of the femoral condyle. Fifteen were women and 6 men. Their average age was 66.9 years. In ten cases the onset of pain was sudden, with a clear previous history of trauma in two of them. Gait pain, effusion, and joint locking were the most frequent clinical symptoms. At the time of diagnosis, 7 patients presented with grade I necrosis, 8 grade II, 1 grade III, and 5 grade IV, following Koshino's classification [11]. The average percentage of osteonecrosis was 36.8%. Six patients underwent conservative treatment with physical exercises and nonsteroidal anti-inflammatory drugs. We performed arthroscopy alone in 4 patients, arthroscopy and drilling in 8, valgus high tibial osteotomy in 2, and total knee arthroplasty in 1. The overall results after an average follow-up 41 months were excellent and good in 76.2% of the cases, fair in 14.3%, and poor in 9.5%. An associated medial meniscus tear was found in half of the patients who underwent surgery. In patients diagnosed with grade III and IV osteonecrosis, no increase in the percentage of necrosis was observed.

[Synovial cyst in the lumbar facet joint. A rare cause of lumbar-sciatic pain]. / Quiste sinovial en articulación interapofisaria lumbar. Una causa infrecuente de lumbociática.

Synovial cysts of the facet joints are uncommon lesions which may be asymptomatic or present as low back pain, with or without radicular symptoms. They are considered to be secondary to trauma or degenerative joint disease, and they occur more frequently in patients with spondylolisthesis. Diagnosis is normally achieved with computed tomography or magnetic resonance, which show a cystic lesion located laterally adjacent to the facet joint. We review the literature and report a patient who presented with first sacral nerve root symptoms attributable to a ganglion cyst of the left L5 S1 facet joint. Treatment was curative and consisted in excision of the cyst.

Radiologic features of Rhodococcus equi pneumonia in AIDS.

This report outlines the radiological features observed in three cases of Rhodococcus equi (R. equi) pneumonia in AIDS (acquired immunodeficiency syndrome) and reviews another 45 radiological reports published of this emerging opportunistic pneumonia in Human Immunodeficiency Virus (HIV) infected patients. The clinical signs in our three patients consisted in a subacute onset of respiratory symptoms and fever. A low lymphocyte count (< 200 cells/mm3), pulmonary infiltrates, and pleural effusion was present in all three cases. Cavitary pneumonia was observed in two patients, and pericardial effusion in another. In this series CD4 lymphocyte count < 200/mm3 was seen in 29 of the 48 patients (60.4%). All 48 patients had abnormal findings on chest radiographs. Abnormalities involved the upper lobes in 26 of the 48 patients (55%). Cavitation was reported in 37 of the 48 cases (77%). R. equi pneumonia may not be as the paucity of case reports suggest. Consequently, a cavitary pneumonia in HIV infected patients with a low CD4 lymphocyte count (< 200 mm3) with a subacute onset, an upper lobe predilection, and/or a poor response to conventional antibiotic therapy should be considered as suspect of R. equi infection.